safety at sea - usna safety at sea/emergen… · a couple of weeks back i attended a safety at sea...
TRANSCRIPT
Dr. Daniel CarlinUSNA Safety at Sea
Safety at SeaMedical Readiness and Response
April 1, 2017
Dr. Daniel CarlinUSNA Safety at Sea
This lecture is dedicated to the memory of all US Navy corpsmen who lost their lives in service to their nation.
Dr. Daniel CarlinUSNA Safety at Sea
Content:
1. Readiness
Your Vessel
Your Destination
Your Crew
2. Medical Response
Dr. Daniel CarlinUSNA Safety at Sea
1. Readiness
Dr. Daniel CarlinUSNA Safety at Sea
Vessel Readiness
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Medical Readiness for Your VesselSecure Storage: Will anything fly if you suffer a
knockdown?
Do you have a preventer? If not, can you perform neurosurgery underway?
Screens and repellants to keep the bugs out
Secure harnesses and jacklines
A comprehensive medical locker
Communication Link: Primary and Secondary
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Vessel Readiness: Medical Locker
Prescription and Controlled Medications
OTC Medications
Bandages, Splints, Betadine
Surgical Equipment
Dental Kit
Reference Book
Crew Medical Records
Duct Tape
A Preventer
Dr. Daniel CarlinUSNA Safety at Sea
1998 2017
Dr. Daniel CarlinUSNA Safety at Sea
Best book
Dr. Daniel CarlinUSNA Safety at Sea
Dangerous High Seas Infection: Treated with Cipro and Tetracycline
Dr. Daniel CarlinUSNA Safety at Sea
Diflucan 100mg. tablet
Dr. Daniel CarlinUSNA Safety at Sea
Betadine: The antibacterial equivalent of duct tape
Dr. Daniel CarlinUSNA Safety at Sea
Random & Useful Stuff
Dr. Daniel CarlinUSNA Safety at Sea
Surgical tools: Use what you know
Dr. Daniel CarlinUSNA Safety at Sea
Training Resource:
https://www.wildmed.com/wilderness-medical-courses/first-aid/offshore-emergency-medicine/
Wilderness Medical Associates International
Dr. Daniel CarlinUSNA Safety at Sea
Destination Readiness
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Medical Readiness for Your Destination• What immunizations do you need?
• What are the local disease risks?
• Is clean water and fuel available?
• Will they bar your entry if you have not had a yellow fever shot?
• Attention esp. if you plan on transiting the Panama Canal.
• Malaria
• Immunizations are not always safe in undeveloped countries. Do it before you go.
Dr. Daniel CarlinUSNA Safety at Sea
Coming Soon to a Marina Near You...
Chickingunya Fever…
…. ChikV
…Chimichanga, Chicken Gumbo
Dr. Daniel CarlinUSNA Safety at Sea
Chickingunya on the
Move
Dr. Daniel CarlinUSNA Safety at Sea
https://www.cdc.gov/yellowfever/maps/
Yellow Fever
Dr. Daniel CarlinUSNA Safety at Sea
Malaria
Dr. Daniel CarlinUSNA Safety at Sea
Crew Readiness
Dr. Daniel CarlinUSNA Safety at Sea
Medical Readiness for the CrewPre-existing medical problems: the most common are
hypertension, chronic back pain, heart disease and poor teeth.
Individual Medications: Who takes what? Do they have an extra supply for the duration?
Serious Allergies
Smokers and Drinkers (At sea is not the time to quit)Seasickness
A Summary Medical Record for Each Member
Dr. Daniel CarlinUSNA Safety at Sea
Men are at risk for:
Back injuries
Heart attacks
Prostate problems
High blood pressure
Kidney stones
Women are at risk for:
Heart attacks
Urinary tract inflections
Yeast infections
Pregnancy
Dr. Daniel CarlinUSNA Safety at Sea
Summary Medical Record
1. Your medical conditions requiring regular attention
2. Past surgeries and inactive medical problems
3. Medications and allergies
4. How to reach your doctor
5. Who to call in an emergency
6. A copy of an EKG
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
2. Medical Response
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Common Illnesses and InjuriesSeasickness / Dehydration
Hypothermia
Heat Exhaustion / Sun Sickness
Lacerations and Contaminated Wounds
Broken bones, injured backs, pulled muscles, wrist tendonitis
Devastating Injuries: Head Trauma, Heart Attack, Major Burns
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Seasickness• Mismatch between what your middle ear feels and what your eyes
see.
• Steer the boat for awhile. Do something on deck.
• Stabilize your neck with a c-collar or towel wrap.
• Lie down, neck stabilized, head slightly elevated, in the lowest center point.
• Meclizine (Bonine) is good before you go.
• Transderm Scopolamine: Test its use first.
• Phenergan suppository is good once symptoms start. Add a decongestant (Sudafed) if you are still queasy.
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Hypothermia
• Starting with: shivering, euphoria, irritability, lethargy
• Proceeding to: stumbling, slurred speech, loss of memory
• Closing with: looking pale, breathing slowly, pulse weak, leading to collapse and unconsciousness
Dr. Daniel CarlinUSNA Safety at Sea
• Wind and being wet lead to rapid heat loss
• Obey the Ocean Dress Code: Layer upon Layer!• Treat it by: Strip him, Dry him, Rack and Sack him, Hot Liquids
• Do not rub limbs, give alcohol or quit CPR
• WARM THE CORE FIRST: THE LIMBS WILL WAIT
Dr. Daniel CarlinUSNA Safety at Sea
Sun Sickness & Skin Cancer
• Sunblock: 50 SPF, waterproof, twice a day. Apply esp. to the ears and tip of your nose.
• Late stage Melanoma is lethal, so look for it first:
-irregular speckled border-bizarre and inconsistent coloration-history of rapid growth
• Fair skinned folks should perform a mole check once a month.
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Lacerations and Wounds
Obey the 3 Rules of Managing Wounds:
1. Open it till you see or feel the bottom.
2. Clean the hell out of it.
3. Make sure the rest of the limb still works.
NEVER, EVER, CLOSE A DIRTY WOUND. Infection and death may ensue.
If in doubt, clean it, pack it with clean gauze, and leave it open
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Stingray spine to the thigh. Venom, salt water, spine sheath.
Dr. Daniel CarlinUSNA Safety at Sea
Boom to the back of the head. Shearing laceration. Low risk.
Dr. Daniel CarlinUSNA Safety at Sea
You must see the bottom of the wound
Dr. Daniel CarlinUSNA Safety at Sea
Rinse, Rinse, Rinse.
Dr. Daniel CarlinUSNA Safety at Sea
Staple/tape it together. Keep the edges up
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
That’s No Way to Accessorize…
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Muscles, Bones, and Backs
The foredeck is where most injuries occur.
An injured back is the complete loss of one able-bodied sailor for the duration.
For all of the above: RICE IT Rest it
Immobilize it with a splint.
Cold and Compress it.
Elevate it.
Check and recheck the blood flow, strength, and sensation downstream from the injury.
Dr. Daniel CarlinUSNA Safety at Sea
Fractured toes. Buddy tape it.
Dr. Daniel CarlinUSNA Safety at Sea
Devastating Injury: Head Trauma, Heart Attacks, & Burns
The most common traumatic death at sea is a head injury from a swinging boom.
Anything more than a minor burn should be evacuated as soon as possible. Force fluids, cleanse gently, antibiotic ointment, cover.
A heart attack is a failure to prepare adequately. If you are over 45, test your own pump before heading offshore
Dr. Daniel CarlinUSNA Safety at Sea
From: SCHULMAN6 [[email protected]]Sent: Tuesday, May 14, 2002 9:40 PMTo: [email protected]
A word of thanks to you Dr. Carlin. A couple of weeks back I attended a safety at sea seminar at Annapolis. I found the entire experience great and tried to learn a little from each of the speakers. What I remembered from your presentation was the importance of preventers in decreasing the possibility of injuries caused by a swinging boom.The week after the seminar, together with two of my sons, I brought a C&C 25 from Providence, RI to the Bronx, NY.At one point, out at the east end of Long Island Sound, rolling west in one of those short chops kicked up by 20ks from the SE, I looked over the boat and asked myself what was missing. I remembered your reference to a preventer, and quickly rigged one.
About a half hour later, while my son was steering, doing more talking than watching, and as I stood in the cockpit looking forward, I heard the swoosh of the main pulled over as the boat rolled the wrong way down a wave. As I looked back I realized that the talking helmsman steered us into an accidental jibe. To my good luck however, the preventer kept the boom from swinging into me, and me into either never, never land or the 50 degree water of the Sound.I hope others at the seminar took away insights and tips as useful and life-saving to them as your reference was to me.Martin Schulman, Woodside, New York
(By the way, the trip, which took three days with anchoring at night, was one of the best of my life. The sea and wind conditions were outstanding, just at the edge of uncomfortable but still exhilarating. The boat, a 25, sailed like a 30 footer, and all of us got along better at the end of the trip than at the beginning.) Thanks again.
Don’t forget to rig that Preventer…
Dr. Daniel CarlinUSNA Safety at Sea
Classic Heart Attack Angina
Dr. Daniel CarlinUSNA Safety at Sea
(because what you can’t see or feel, can kill you)
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Preventive Medicine on the High Seas
Stretch out your back every time you leave your rack. Knee to chest and twist, switch legs
Obey the Ocean Dress Code
Did I mention the part about a preventer?
Drink lots of fluids to help stabilize your core temperature and prevent dehydration
If you are over 35… take a baby aspirin, take your meds, and look after your crew/spouse.
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: What to Do in an Emergency
Stay calm. People rarely die suddenly.
Move the patient to a secure bunk.
Splint and immobilize the neck of anyone complaining of neck pain before you move.
Find out exactly what happened.
Call your medical resource: Report the situation clearly and calmly. Use a form.
Clarify all advice you receive.
Dr. Daniel CarlinUSNA Safety at Sea
Medical Response: Radio Medical Advice Resources
The US Coast Guard
DH MEDICO on the SSB
Passing ships
Commercial Medical Advisory Services ($4-9k/year)Medical Advisory Systems Inc. 301-855-8070
Dr. Daniel CarlinUSNA Safety at Sea
WorldClinic Maritime Membership
24/7 Immediate Access to WorldClinic Emergency
Physicians
Destination Medical Risk Briefs
Portable Medical Kits
Summarized Medical Records
$1,200/person/year
Dr. Daniel CarlinUSNA Safety at Sea
How to Die Underway
Drown: after falling overboard while urinating
Roast: hyperthermia
Freeze: hypothermia
Seasickness: leading to impairment of judgement
Injury: leading to loss of skipper at a bad time
Bad Heart: too far from land
Drive, esp.. at night, in a developing country
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
Dr. Daniel CarlinUSNA Safety at Sea
“Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.”
—H. Jackson Brown